by Jerome Groopman
Penguin USA, 1997
Review by Christian Perring, Ph.D. on Sep 9th 1998
Jerome Groopman is an internationally respected researcher on cancer and AIDS, and he is also a clinician who deals with patients on a regular basis. His book is a collection of stories of people he helped to treat in his practice over the last decade or so. So ostensibly the subject matter is the treatment of fatal illnesses, and Groopman tells his readers in some detail about cancer, AIDS, the latest research about them and methods of fighting them. But Groopman's real subject is psychological or spiritual; what death means for us and how facing death changes us.
Each chapter is devoted to a different patient, as most medical/psychotherapeutic tales are these days. The danger of this format is that each chapter becomes a fable with its own trite moral, but Groopman is circumspect enough to largely avoid this. He comes across as a wonderful doctor, wise, compassionate and devoted to his work. His patients, on the other hand, are full of human longings, fears, regrets, and weaknesses. The first patient we meet is Kirk, an obsessive venture capitalist who at first is determined to beat his cancer. His experience of fighting the disease shows his how shallow his life has been and he loses the will to continue the fight. Cindy contracts AIDS before she has been able to fulfill her dream of getting married and having children, so despite Groopman's misgivings, she decides to adopt. Debbie refuses traditional medicine in favor of alternative treatments to treat her cancer, and Groopman devotes his energies to trying to convince her of her folly and its fatal consequences. In these stories he emphasizes both his belief in scientific method, how unpleasant and dangerous are the existing treatments, and the limitations of those treatments. Many times he struggles to balance his personal reactions to patients with those required of him as a physician. By the end of the book the reader is left with a sense of moderated hope and some clues about how to cope with one's humanity.
Groopman shows how he is able to empathize with his patients because of his previous experience with serious illness, and he gives us many details about the patients' lives. The book is unusual in that it does not come with the usual qualification that names have been changed to protect privacy, or that the clinical vignettes are in fact composites of several different cases. So far as we know, the details we have, including names, are all true. This gives some sense of added reality, but nevertheless, I still felt that the patients were being observed from a distance. We never fully understand what they are going through. So the book is most informative about Groopman himself, and his views of the world, and his relationships with his family, close friends and colleagues. I learned a lot from the book, but I was left wanting a different perspective, from other points of view.